Biomedical Engineering Reference
In-Depth Information
2.2.3
Monitoring Individual Functioning in the Context
of an AT Use: The Outcome of the ATA Process
The outcome analysis represents the focal point of the assistive solution matching
process and is conducted by the multidisciplinary team of a center for technical aids. It
is fundamental to point out some of the factors that can convey important information
about the pertinence of an assistive solution to replace, update, and support its adoption
by the end-user and prevent its abandonment. The outcome can be analyzed by means
of the clinical diagnosis, the functional state, the quality of life, the cost, the satisfaction
(DeRuyter 1995), and the comfort (Weiss-Lambrou et al. 1999). In particular, the analysis
of two multidimensional constructs enables different degrees of intensity to describe the
user's experience of assistive technology (AT): satisfaction (Demers et al. 2000) and comfort
(Kolcaba 1992).
Satisfaction is a positive attitude toward psychosocial factors concerning subjective
perceptions, evaluations, and comparison processes (Linder-Pelz 1982). The user can
describe this kind of positive attitude toward health-care services, products, and providers
and toward individual health conditions (Weiss-Lambrou 2002). Comfort can be a physical
sensation, a psychological condition, or both things simultaneously (Pearson 2009), and it
can generally be reported as a pleasant and positive sensation (Kolcaba and Kolcaba 1991).
Another parameter to take into consideration is the environment of use, which involves
the user's characteristics and the goals he/she wants to reach with adoption of the AT. An
environmental investigation focuses on the person-environment system whereas the user
interacts with the given technology (Rust and Smith 2006).
Different studies have highlighted the fact that there are high rates of AT abandonment
of up to 75% (Garber and Gregorio 1990; Philips and Zhao 1993; Tewey et al. 1994; Gitlin
1995). However, the causes of abandonment are rarely due to the features of the aid (func-
tioning, manageability, etc.), but they do concern the absence of a user's involvement and/
or his/her caregiver in the matching process.
The evaluation process of AT matching must be user-centered and, moreover, it must
aim to identify the best correspondence between individual user needs and the features
of a particular technology available in a given historical period (Gelderblom et al. 2009).
Abandonment can also be due to unnecessary AT; for example, because of the user's recov-
ery, some authors suggested the use of “discontinuity” to describe a possible result of the
AT matching process, remarking in this way that the term “abandonment” has a purely
negative connotation, whereas the term “discontinuity” generally has a neutral connota-
tion (Lauer et al. 2006).
For all of these reasons, some of the evaluation tools that are able to analyze technical
aid matching and that are based on the ICF (Scherer and Craddock 2002) and the client-
centered approach have been proposed. The models mentioned highlight the fact that the
more we focus on the object (the AT) the more we move away from a good match. In this
way, the problem of a good match lies more in the matching process than only in the
technology itself; indeed, it is fundamental to involve both users and caregivers in the
AT matching process (Long et al. 2003). Starting from this perspective, it is possible to
distinguish between AT as a tool and AT as a service. To facilitate both the use of AT and
the possibility of examining the chosen technology, it is important to create an assistance
network around the user within the evaluation process.
The “Consortium model” describes a matching process centered on the participation of
users and caregivers (Long et al. 2003). In this model, the user's family and health workers
intervene at the start of the matching process (“Evaluation, identification of outcomes”),
